研究背景：
失智症是腦部進行性退化疾病，病程進展至死亡已屬不可避免，若能讓病人或家屬預先了解無效的心肺復甦術所造成之傷害及延滯痛苦的死亡過程，不但有助於減少不必要的醫療耗費及更能維護失智症病人臨終照護的品質。
目的：
探討急性醫療機構門診失智老年病人的家屬對病人接受不施行心肺復甦術意願之現況，以及探索影響此意願之相關因素。
方法：
採橫斷式、描述性研究，研究對象為南部某醫學中心神經科失智症門診之失智症病人與其代理家屬。資料以病歷回顧與問卷調查方式收集。測量變項含失智症病人、代理家屬特質及有無不施行心肺復甦術意願與相關資料，以邏輯式迴歸分析各項特質與影響簽署不施行心肺復甦術意願之相關性。
研究結果：
本研究共收案失智症病人的家屬223位，其中表達有意願代理簽署不施行心肺復甦的有140位（62.78%），而這140位中，88.57%為病人的配偶或直系親屬。進行多變項邏輯式迴歸分析後，發現影響失智症病人的家屬不施行心肺復甦術意願之相關的因素有病人之重複言語與行為之精神症狀（P<0.01, OR = 2.77, 95% CI = 1.30–5.91）、家屬與病人的關係為配偶（P<0.01, OR = 9.79, 95% CI = 1.88–50.93）或直系親屬（P<0.002, OR = 4.59, 95% CI=1.76–11.93）、曾與病人討論過不施行心肺復甦（P<0.001, OR = 5.73, 95% CI=2.15–15.24）等，而宗教信仰中以西方宗教較一般民間信仰較無意願簽署不施行心肺復甦術之決策（P<0.005, OR = 0.25, 95% CI=0.10–0.66）。
結論：
超過六成失智症病人的家屬有意願代理病人簽署不施行心肺復甦術決策，其主要相關因素包括病人之重複言語與行為之精神症狀；與病人的關係為配偶或直系親屬；曾與病人討論過不施行心肺復甦的家屬會尊重病人交代的意願，以及宗教信仰為民間信仰的家屬，可能其生死觀較偏向於軀體自然死亡等。為促進失智病人DNR醫囑的推行，應鼓勵家屬尤其是配偶與直系親屬在病人認知障礙尚未嚴重前即和病人做相關討論。未來研究者可進一步探討初期失智症病人或家屬對不施行心肺復甦術決策意願看法、需求、與決策過程，將有助於失智症病人於生命末期的照護品質。

Dementia is a progressive disease that ultimately leads to death. To improve the quality of care for patients with dementia (PwD), end-of-life care plan must begin as early as possible when the patient is still communicable. In this study, we investigated the prevalence of do not resuscitate intention and influencing factors among family surrogates of PwD. A descriptive and cross-sectional study with chart review and questionnaire survey was conducted. Subjects were recruited from a Dementia Out-patient Clinic of a teaching hospital in southern Taiwan. Data were analyzed by correlation and multiple logistic regressions. Findings of this study indicated that factors influencing families’ intention of DNR for their dementia relatives were: psychological symptoms of repetitive wording and behavior; spouse and immediate relatives of patient; previous discussion between family and patient about DNR policy. However, DNR policy is less acceptable for western religious believers (Christianism or Catholicism) than those of Taiwanese folk religious believers (Buddhism or Taoism). Our study showed that spouse and immediate relatives of PwD are more likely to agree DNR for patient. Discussion of DNR policy with patients while they are still communicable can help key families to accept DNR policy. Early education to patients and their key families about DNR policy is important to promote the advance directive of DNR for PwD and improve quality of end-of-life care of this group of patients.

中央健康保險局新聞稿：今（2009）年 9 月 1 日起，新增八類非癌症重症末期病患也能接受安寧療護服務，並正式納入健保給付。Available from: http://www.nhi.gov.tw/information/News_detail.asp? News_ID=808&menu=9&menu_id=544.
內政部統計處-我國生命表（2014）：民國103年全國簡易生命表。Available from: http://www.moi.gov.tw/stat/life.aspx
方慧芬、張慧玉、林佳靜（2009）．末期病人面臨預立醫囑、生前預囑之現況及與生命自決之倫理議題．護理雜誌，56（1），17-22。
古鯉榕、王榮德、白明奇（2013）．台灣失智症疾病成本估計（計畫編號NSC102-2410-H006-001-SS2）．國立成功大學醫學系公共衛生科暨研究所。
台灣失智症協會（2014）．最新活動消息．Available from http://www.tada2002.org.tw/tada_event_detail.aspx?pk=484
波仕特（Pollster）線上市調網（2010）：波仕特最新市調發表-宗教信仰深入台灣民間，信仰佛教與道教最多。Available from:http:// www.pollster.com.tw/Aboutlook/lookview_item.aspx?ms_sn=1079
林克能、王培寧、劉秀枝、陳榮基（2012）．失智症倫理議題：患者、家屬與醫療人員的共同問題．應用心理研究，55，101-113。
林克能、劉秀枝（2003）．臨床失智評量表．Acta Neurologica Taiwanica，12 （3），154-165。
林慧美、楊嘉玲、陳美妙、邱泰源、胡文郁(2011)．住院病人簽署預立醫療指示的意願及接受宣導的意向。安寧療護雜誌，16(3)，281-295。
林綉君（2015）．探討中老年病人及家屬對預立醫療指示的認知與決策情形-以中部某醫學中心加護病房為例．成功大學老年學研究所碩士論文。
周希諴（2012）．失智症末期的安寧緩和醫療照護．應用心理研究，55， 115 -153。
吳俊穎、賴惠蓁、陳榮基（2010）．不施行心肺復甦術之相關法律議題．台灣醫學， 14 （3），318-323。
吳讚美、薛爾榮、鍾春櫻、劉慧玲、溫怡然、鐘裕燕（2009）．癌症死亡病人不施行心肺復甦術簽署情形與是否簽署之相關因素分析．安寧療護雜誌，14（3），243-253。
洪玉馨 、吳維珊 、黃韻琴 、章甄凌、林均澄 、徐海蓓、周文其（2010）．失智症住院病人的安寧照護──北區某區域教學醫院經驗分享．安寧療護雜誌 ，15 （2）， 161-170。
張惠雯、顏啟華、林鵬展、劉立凡（2011）．病人對預立醫囑的看法－以彰化某醫院家庭醫學科門診病人為例．安寧療護雜誌 ，16（3），296-311。
陳宇菁（2007）．加護病房家屬代理病人的DNR決策．國立台北護理學院護理研究所碩士論文。
陳冠宇（2008）．失智症首發率與盛行率之推估 --以台灣全民健康保險2000年承保抽樣歸人檔為基礎．東吳大學商用數學系碩士論文。
陳榮基（2008）．以拒絕臨終急救預約善終．台灣醫學，12，470-72。
陳榮基（2000）．不再與死神抗衡-台灣回歸人性醫療的契機．醫望雜誌，31，32-35。
傅中玲（2008）．台灣失智症現況，台灣老年醫學暨老年學雜誌，3（3），169-181。
張佳琪、林佳靜（2009）．失智患者拒食行爲之倫理相關議題．新臺北護理期刊，11（2），63-70。
郭乃文、劉秀枝、王珮芳、徐道昌 (1989)．中文版「簡短式智能評估」(MMSE)之簡介．臨床醫學，23，39-42。
黃錦鳳（2006）．加護病房重症病人簽署不予急救同意書對醫療處置之影響．台北醫學大學護理學研究所碩士論文。
黃韻琴、洪玉馨、章甄凌、吳維珊、林均澄、徐海蓓、周文其（2010）．失智症的安寧緩和照護．安寧療護雜誌，15（1），94-105。
楊國樞、瞿海源編（1988）．《變遷中的台灣社會》．239-276。台北：中央研究院民族學研究所。
鄭志明（2000）．道教之生死觀．生死學研究通訊，3。
劉淑娟（2007）．長期照護．台北：華杏。
劉景寬、戴志達、林瑞泰、賴秋蓮（2000）．台灣失智症的流行病學．應用心理研究，7，157 – 169。
衛生署醫政處（2000）．安寧緩和醫療條例．華總一義字第八九零零一三五零八零號。
衛生福利部醫事司（2013）．安寧緩和醫療條例部分條文修正案．華總一義字第一零二零零零零零八一一號令公布。
衛生福利部醫事司（2015）．病人自主權利法．中華民國一百零五年一月六日總統華總一義字第一零四零零一五四零六一號令制定公布全文 19 條；並自公布後三年施行。
羅玉岱（2009）．護理之家住民不施行心肺復甦決策之現況與影響因子之探討．國立成功大學老年學研究所碩士論文。
Agard, A., Hermeren, G., & Herlitz, J.(2000). Should cardiopulmonary resuscitation be performed on patients with heart failure? Tho role of the patient in the decision-making process. Journal of Medicine, 248(4), 279-286.
Al Husseini, D. I. (2011). The Implications of Religious Beliefs on Medical and Patient Care. University of Pennsylvania ScholarlyCommons. Available from http://repository.upenn.edu/od_theses_msod/46
Ali, G. C., Guerchet, M., Wu, Y. T. Prince, M.& Prina, M.(2015), The Global Impact of Dementia, World Alzheimer Report 2015, 10-29.
Bachman, D. L., Wolf, P. A., Linn, R. T., Knoefel, J. E., Cobb, J. L., Belanger, A. J., ... & d'Agostino, R. B. (1993). Incidence of dementia and probable Alzheimer's disease in a general population The Framingham Study. Neurology, 43(3 Part 1), 515-515.
Burns, J. P., Edwards, J., Johnson, J., Cassem, N. H. & Truog, R. D.(2003). Do-not-resuscitate order after 25 years. Critical Care Medicine, 31(5), 1543-1550.
Cheng,Y., Wang. J., Wu, K., Huang, S., Kuo, M., & Su, C. (2016). Do-not-Resuscitate orders and related factors among family surrogates of patients at the emergency department. Supportive Care in Cancer. accepted
Chao, C. S. (2002). Physicians attitudes toward DNR of terminally ill cancer patients in Taiwan. Journal Nursing Research, 10(3), 161-167.
Cranston, R. E. (2001), Advance Directives and "Do Not Resuscitate" Orders, The Center for Bioethics and Human Dignity. Available from http://cbhd.org/content/advancedirectives-and-do-not-resuscitate-orders
Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189-198. http://dx.doi.org/10.1016/0022-3956(75)90026-6
Frank, C., Heyland, D. K., Chen, B., Farquhar, D., Myers, K., & Iwaasa, K. (2003). Determining resuscitation preferences of elder inpatients:a review of the literature. Canadian Medical Association Journal, 169(8), 795-799.
Heron, M., Hoyert, D. L., Murphy, S. L., Xu, J., Kochanek, K. D., Tejada-Vera, B., et al. (2009). Deaths: Final data for 2006. National Vital Statistics Report, 57(14), 1－135.
Hughes, C. P., Berg, L., Danziger, W. L., Coben, L. A., & Martin, R. L. (1982). A new clinical scale for the staging of dementia. The British Journal of Psychiatry, 140, 566-572.
Lambourne, P. & Lambourne, A. (2001). Do Not Resuscitate policies — what do staff and relatives want for patients with severe dementia?. Geriatric Psychiatry, 16(11), 1107-1108
Lin, T. Y., Rin, H., Yeh, E.K. (1996). Mental disorder in Taiwan fifteen years later: A preliminary report. In W. Caudell. Lin TY, Mental Health Research in Asia and the Pacific. Honolulu: East-West Center Pres , 66-91.
Liu, C.K, Lin, R.T., Chen, Y. F., Tai, C.T., Yen, Y. Y., Howng, S. L. (1996). Prevalence of dementia in an urban area in Taiwan. Journal of Formos Medical Association, 95(10), 762-768.
Liu, H. C., Lin, K. N., Tsou, H. K., Lee, K. M., Yan, S. H., Wang, S. J., & Chiang, B. (1991). Impact of demented patients on their family members and care-givers in Taiwan. Neuroepidemiology, 10(3), 143-149.
Liu, J. M., Lin, W. C., Chen, Y. M., Wu, H. W., Yao, N. S., Chen, L. T. & Whang-Peng, J. (1999). The status of the do-not-resuscitate order in Chinese clinical trial patients in a cancer centre. Journal of Medical Ethics, 25, 309-314.
Luchins, D. J., Hanrahan, P., & Murphy, K. (1997). Criteria for enrolling dementia patients in hospice. Journal of the American Geriatrics Society, 45(9), 1054-1059.
Lo, Y. T., Wang, J. J., & Wang, C. N. (2010). Prevalence and related factors of Do-Not-Resuscitate directives among nursing home residents in Taiwan. American Medical Directors Association, 436- 442
.Mackler, A. L. (2003). Jewish and Catholic Bioethics: A comparative Analysis. Georgetown University Press, Washington D.C.
Marenco, J. P., Wang, P. J., Link, M. S. & Homoud, M. K., Estes, N. A. 3rd (2001). Improving survival from sudden cardiac arrest: the role of the automated external defibrillator. The Journal of American Medical Association, 285, 1193-1200.
Messinger-Rapport, B. J., & Kamel, H. K. (2005). Predictors of do not resuscitate orders in the nursing home. Journal of the American Medical Directors Association, 6(1), 18-21.
Mitchell, S. L., Teno, J. M., Kiely,D. K., Shaffer, M. L., Jones,R.N., Prigerson,H. G., Volicer,L., Givens,J. L., & Hamel, M. B.(2009). The Clinical Course of Advanced Dementia. The New England Journal of Medicine, 361(16)：1529-1538.
National Center for Health Statistics (NCHS) （2003）. Highlights of a New Report from the National Center for Health Statistics Mortality Trends for Alzheimer's Disease. Available from http://www.cdc.gov /nchs/ releases/96facts/fsalzhe.htm. Accessed August 14.
National Hospice Organization. Medical guidelines for determining prognosis in selected non--cancer diseases, 2nd ed Arlington, VA: NHPCO, 1996.
National Vital Statistics Report. (2006, August). Death, preliminary data for 2004. Available from http://www.cdc.gov/nchs/data/nvsr/nvsr54/nvsr54_19.pdf.
O'Connor, D. W., Pollitt, P.A., Hyde, J. B., Fellows, J. l., Miller, N. D., Brook, C. P. B., Reiss, B. B. (1989). The reliability and validity of the mini-mental state in a British community survey. Journal of Psychiatric Research, 23(1), 87-96.
Perneczky, R., Wagenpfeil, S., Komossa, K., Grimmer, T., Diehl, J.,& Kurz, A.(2006). Mapping scores onto stages: mini-mental state examination and clinical dementia rating. American Journal of Geriatr Psychiatry,14(2), 139-44.
Rocca,W.A., Hofman,A., Brayne,C., Breteler, M. M., Clarke, M., Copeland, J. R. & …Heeren, T. J. et al. The prevalence of vascular dementia in Europe: facts and fragments from 1980-1990 studies. EURODEM-Prevalence Research Group. Ann Neurol, 30(6), 817-824.
Sampson, E. L., Burns, A. & Richards, M. (2011). Improving end-of-life care for people with dementia, The British Journal of Psychiatry, 199, 357-359. doi: 10.1192/bjp.bp.111.097030
Sandroni, C., Nolan, J., Cavallaro, F., &Antonelli, M. (2007). In-hospital cardiac arrest: incidence, prognosis and possible measures to improve survival. Intensive Care Medicine, 33, 237-245.
Schiff, R., Rajkumar, C., Bulpitt, C. (2000). Views of elderly people on living wills: interview study. British Medical Journal, 320, 1640-1641.
Skerritt, U. (1997). Do not resuscitate, Journal of Psychiatric Practice, 10(4), 261-336.
Volicer, L.(2005). End-of-life Care for People with Dementia in Residential Care Settings, Alzheimer's Association.
WHO (2015). http://www.who.int/mediacentre/factsheets/fs362/en/
Wolfson, C., Wolfson, D.B., Asgharian, M., M’Lan, C.E., Østbye, T., Rockwood, K. & Hogan, D.B.(2001). A reevaluation of the duration of survial after the onset of dementia. The New England Journal of Medicine, 344(15), 1111-1116.